Prosthetic fitting and training
Facility: Providence Medical Center
Billing Code: 97761 (CPT)
- CPT Billing Code: 97761
- Insurance Median: $40
- Cash Discount Price: $38
- vs. Medicare Baseline: 0.99x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $40.41 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $20 - $137 | 49% |
| Medicaid / KanCare | $20 | 49% |
| Celtic | $21 - $61 | 52% |
| Healthy Blue | $21 - $40 | 52% |
| Aetna | $24 - $38 | 59% |
| Tricare | $38 | 94% |
| Cigna | $38 | 94% |
| Blue Cross Blue Shield | $38 - $91 | 94% |
| Midland Care Connection | $38 | 94% |
| Medicare (plans) | $38 | 94% |
| Kansas Superior Select | $40 | 99% |
| Corizon | $49 | 121% |
| Well Path Prison | $53 | 131% |
| Employer Direct Healthcare | $53 | 131% |
| Centurion | $57 | 141% |
| Naphcare | $59 | 146% |
Consumer Guidance & Cost Commentary
For the CPT code 97761, representing prosthetic fitting and training, the gross charge at Providence Medical Center in Kansas City, KS is $372.00. This facility is a voluntary non-profit acute care hospital, and while the Medicare benchmark for this service is $40.41, the actual negotiated rates vary significantly by payer. Medicaid/KanCare has a single plan with a fixed rate of $20.00, whereas UnitedHealthcare covers six plans ranging from $20.00 to $137.00. Other major payers like Blue Cross Blue Shield and Celtic show a wider spread, with negotiated amounts between $38.00 and $91.00. It is important to note that these negotiated rates often exceed the cash price of $38.00, which can be beneficial for patients with high-deductible plans who have not yet met their out-of-pocket limits.
When evaluating costs, it is crucial to distinguish between the facility's negotiated rates and the broader state or county averages, as commercial insurance contracts can create substantial price variations. Patients should verify their specific plan's allowed amount before scheduling, as being in-network does not guarantee the lowest possible price; some in-network facilities charge significantly more than others. Additionally, patients should proactively inquire about "self-pay" or "prompt-pay" discounts, which can offer a fee reduction of 20% to 50% for upfront payment. This bypasses the administrative overhead associated with insurance claims processing and can result in a lower final bill than the standard negotiated rate. Finally, if a balance bill arises from out-of-network ancillary services, patients are protected under